Obamacare (ACA)

I’m not addicted to opioids, I can stop anytime I want to but I just don’t want to.

The Senate Homeland Security Committee released a report in mid-January that received surprisingly little media attention despite its provocative assertion that Obamacare, and particularly its enormous expansion of Medicaid, is a driving force behind the opioid epidemic.

The case laid out by the report is straightforward, logical, and politically unspeakable. It’s an argument generally made in hushed tones until now, and it’s easy to see why. Even the Senate Homeland Security report was swiftly denounced as a “partisan fantasy” peddled by chairman Ron Johnson (R-WI) in what little mainstream media coverage it received. Thou shalt not speak ill of Medicaid.

Older people are becoming addicted to opioids also.

And yet, the critics could find no way to refute the actual data in the report. They denounced it with thunderous virtue-signaling outrage, attacked those involved in preparing it, criticized arguments it did not make – such as pretending the report claims the opioid epidemic was caused by Medicaid expansion, rather than exacerbated by it – or simply assumed that all critiques of Medicaid and Obamacare must be partisan hit jobs, Q.E.D.

This validates one of the core concerns about politicizing medicine, or any other scientific field, by putting Big Government in charge of it. Rational discussion becomes impossible. Every analysis quickly devolves into a partisan brawl.

The report postulates Medicaid expansion is a contributing factor to the epidemic of opioid abuse – not the sole or original cause, as the report itself and Sen. Johnson took pains to point out, despite mischaracterizations by critics. Much of the opioid crisis involves prescription drugs, which can become addictive even when legitimately prescribed, and are often stolen through fraud and resold on the street. Medicaid expansion greatly increased access to prescription drugs. Medicaid also includes programs to fight drug abuse, but some of those programs involve pharmaceutical treatments that can themselves become addictive, especially when they fall into the hands of street pushers.

It requires no great leap of logic to see the connection between a dramatic increase in access to drugs and a problem driven by easy access to drugs, and yet it is evidently heretical to state that relationship out loud. That’s even more remarkable when the increased use and abuse of painkillers is universally acknowledged as a major element of the opioid crisis.

No one seems to have trouble acknowledging that fact when blaming pharmaceutical companies for creating and pushing drugs, doctors for over-prescribing them, or Americans for reporting remarkably high levels of pain and demanding truckloads of pills to deal with it. The Senate report itself states at the very beginning that the opioid epidemic is complicated, and “most agree that development, marketing, and medical training regarding drug usage – and the resulting over-prescription of opioids – have played a key role.”

Ask if a massive government program that makes it much easier for over one-fifth of the population to get drugs could be part of the problem, however, and you’re a hyper-partisan monster who really just wants to kill poor people by taking away their Obamacare. The Senate committee demonstrated its understanding of just how hot this political potato is by filling the early pages of the report with lavish praise for Medicaid and its good intentions, and repeatedly stating that government spending on drugs is but one factor in a complex crisis that deserves careful analysis.

The report studied hundreds of cases in which Medicaid was abused and defrauded to obtain opioids that were often resold on the streets. The report quotes Sam Quinones’ award-winning book Dreamland: The True Tale of America’s Opiate Epidemic to explain why this outcome was entirely predictable: “We can talk morality all day long, but if you’re drawing five hundred dollars a month and you have a Medicaid card that allows you to get a monthly supply of pills worth several thousand dollars, you’re going to sell your pills.”

Some of the fraud cases detailed in the report go far beyond individual beneficiaries making the sort of calculation Quinones described. Some of them were organized conspiracies involving large numbers of Medicaid beneficiaries recruited to provide inventory to drug dealers. The largest scheme chronicled in the report saw over a billion dollars change hands.

A police officer quoted in the report observed that pharmacists are more likely to fill dubious prescriptions when Medicaid is involved. The Justice Department launched a program over the summer to study the role played real and fraudulent prescriptions for opioids in the drug crisis.

The Senate Homeland Security report further notes that Medicaid fraud is rampant and has not been handled effectively by the government, a fact known to any serious student of the waste, fraud, and abuse that politicians of both parties vow to crack down upon during every election.

Other fraud-susceptible programs such as Medicare, the VA, and the food stamp program are duly cited by the report as sources of opioids.

(Yes, the food stamp program. Among other things, it is well-known to investigators that some SNAP card holders engage in “trafficking” of their benefits, and often purchase drugs with the money they receive. This has been specifically cited as a contributing factor to the opioid crisis. Also, shop owners have been prosecuted for allowing customers to use SNAP benefits to pay directly for forbidden items. One such case documented in the Senate report involved a small grocery store with a back-room stash of “Medicaid-funded OxyContin pills.”)

“The research suggests, however, that Medicaid is the federal program most prone to abuse, and the primary government funding source for the epidemic,” the authors point out.

“There appears to be no limit to the types of schemes used to scam the Medicaid program, from large drug rings that employ beneficiaries as ‘runners’ to fill oxycodone prescriptions, to nurses working the night shift who steal hydrocodone pills from patients. Illicit painkillers obtained with Medicaid cards are being resold at handsome profits nationwide, in places ranging from the streets of Milwaukee to a Native American reservation in upstate New York,” says the report.

Another problem is the illicit use of drugs intended to treat drug addiction, notably suboxone. The attorney general of Kentucky is quoted declaring that “wrongful prescribing of suboxone is flooding our communities with yet another drug that is killing our children.”

It’s not just illicit street purchases increasing in tandem with Medicaid expansion. National Review points to Centers for Disease Control data that “opioid prescribing rates among Medicaid enrollees are at least twofold higher than rates for persons with private insurance.” In Washington State, the CDC found that Medicaid beneficiaries were 5.7 times more likely to die of opioid-related causes.

The most provocative section of the report introduces facts and figures to buttress the argument that opioid abuse has grown worse in states that expanded Medicaid under Obamacare.

“More than 80 percent of the 298 separate Medicaid-opioids cases identified were filed in Medicaid expansion states, led by New York, Michigan, Louisiana, New Jersey, and Ohio,” the report states. “The number of criminal cases increased 55 percent in the first four years after the Medicaid expansion, from 2014 to 2017, compared to the four-year period before expansion.”

It is further noted that drug overdose deaths are increasing almost twice as fast in expansion states, hospital stays for opioid-related issues “massively spiked” after expansion, and Medicaid spending for drug abuse treatment is rising faster in expansion states.

Conversely, as Investors Business Daily notes, eight of the 15 states with the lowest overdose rates did not expand Medicaid. All of these observations should be considered with the usual caveat that correlation does not necessarily indicate causation – there are almost certainly other factors common to expansion states that help to explain their rising addiction rates, although the dramatic increase immediately after the expansion is not easily dismissed.

These assertions are based on official figures that most analysts agree are significantly under-stating the depths of the opioid crisis. One specialist quoted in the Senate report said the opioid epidemic is “deadlier than the AIDS epidemic at its peak.”

Reviewing the Senate Homeland Security report for Forbes, Sally Pipes notes that state Medicaid expansion had the perverse effect of “enrolling able-bodied, childless adults in their Medicaid programs than it does for children and the destitute elderly.” Able-bodied childless adults are also the group experiencing an anomalous increase in mortality rates, which in turn is believed to be strongly influenced by opioid addiction.

“About 80 percent of heroin and fentanyl users spiraled into their addictions after first getting hooked on prescription painkillers. The Medicaid expansion made those painkillers widely and cheaply available,” Pipes notes, succinctly stating the point nobody is supposed to make.

She also tackles the bizarre argument that Medicaid is a net plus because it treats more drug addicts than it creates, which is the sort of argument that only makes sense to people whose capacity for reason has been eroded by decades of worshipping Big Government. (Try this argument for comparison purposes: “Tobacco companies are a net plus for public health because they provide so much funding to treat smoking-related illnesses.”)

Pipes suggests addressing the crisis by rolling back the Medicaid expansion and block-granting funds to states, which could help to drain the bureaucratic swamp that hides so much Medicaid corruption and strongly incentivize states to watch their health-care dollars more carefully.

Such suggestions run strongly against the current political tides, with Democrats pushing hard for even more centralized political control of medicine and ever-larger bureaucracies, with an eye toward midwifing the birth of the doomsday bureaucratic monstrosity known as single-payer socialized medicine. Imagine how bad the opioid crisis will get if everyone gets Medicaid.

But of course, you’re not supposed to imagine that, much less conduct hard research into any aspect of the absolutely forbidden notion that government makes problems worse by subsidizing them.

Senator Paul wrote in an exclusive op-ed for Breitbart News, “That’s a good question. I say yes, but I tell you this – it’s hard to say yes if we can’t do something as simple as keeping our word. As simple as voting today how we voted before when we were asking to be in charge. If you tell people you’re going to do something, do it. It’s just that simple. Let’s repeal Obamacare.”

After his bill failed, Sen. Paul argued, “It’s a victory for conservatives that we did get a vote for a clean repeal.”

Not only have these six senators voted to repeal Obamacare, they publicly pledged to do so on the campaign trail and in the halls of the Senate. Here are six times these senators promised to repeal Obamacare:

Lamar Alexander, “The wisest course is to repeal Obamacare and replace it step by step with solutions that lower health care costs.”

Shelley Moore Capito, “I have consistently voted to repeal and replace this disastrous health care law, and I am glad that a repeal bill will finally reach the president’s desk.”

Dean Heller,“This DC bureaucrat-driven healthcare system will only result in limited health care choices and higher costs for Nevadans.”

Lisa Murkowski, “This law is not affordable for anyone in Alaska. That is why I will support the bill that repeals the ACA and wipes out its harmful impacts. I can’t watch premiums for Alaskans shoot up by 30 percent or more each year, see businesses artificially constrained, or see the quality of public education decline.”

John McCain, “It is clear that any serious attempt to improve our health care system must begin with a full repeal and replacement of Obamacare, and I will continue fighting on behalf of the people of Arizona to achieve it.”

Rob Portman, “I’m for repealing this broken law and replacing it with something better that gives patients more choice, decreases costs and increases access to quality, affordable care.”

FreedomWorks President Adam Brandon called out the Senate’s six hypocrites. Brandon charged, “Our activists have fought for the better part of a decade, led on by campaign promises and actual votes to repeal Obamacare, to get Republican majorities in the House and Senate, as well as a Republican in the White House. Sens. Dean Heller, Lisa Murkowski, John McCain, Rob Portman, Shelley Moore Capito, and Lamar Alexander each voted for the very same bill in 2015. We now know that these six senators are Obamacare repeal frauds. Even though we’re still wondering if Sen. Susan Collins is in the right party, at least she was consistent with her vote.”

Tea Party Patriots President Jenny Beth Martin said that the seven senators who voted against the clean Obamacare bill broke the biggest political promise in history. She said:

Today, seven Republican Senators betrayed their constituents and the American people by breaking what is arguably the biggest political promise in modern American politics, and refusing to vote to repeal Obamacare. For the last four election cycles, Republican candidates have promised to repeal Barack Obama’s signature legislation and as a result, have increasingly been granted more power in Washington by the American people. Now, Republicans are completely in charge and should find it easy to keep this critical promise that lifted them to power. However, Senators Capito, Heller, McCain, Portman, Alexander, and Murkowski should be ashamed for having flip-flopped and voting against repealing Obamacare, just 18 months after they voted to send virtually the same exact legislation to President Barack Obama’s desk. And the seventh, Susan Collins, seems more concerned with critiquing the looks of House members or the sanity of the president than providing relief to the American people from rising costs and deteriorating quality of care under Obamacare. This is precisely the reason President Trump was elected. It is precisely the reason Congress has an approval rating worse than cockroaches. And it is precisely why the American people voted to drain the swamp in 2016. Tea Party Patriots will never give up the fight to fully repeal Obamacare and restore health care freedom to the American people. We call on President Trump to take action to end the congressional exemption from Obamacare so that senators, their families, and theirs staffs are forced to experience the same hardships that they refuse to lift from the American people. Perhaps if they were forced to live under the law that was unfavorably imposed on the American people, they will finally have the motivation to repeal Obamacare once and for all.

Americans for Limited Government President Rick Manning issued a statement condemning the six moderate senators who voted to repeal Obamacare in 2015 but have reneged on their promise to the American people. Manning declared

It is sad to see six Republican Senators, John McCain, Shelley Moore Capito, Dean Heller, Lisa Murkowski, Rob Portman and Lamar Alexander who voted in 2015 to repeal most of Obamacare have now decided to change their votes when it actually mattered and there’s a president in the White House who wanted to sign the bill. This betrayal of their constituents’ trust threatens to leave the failed Obamacare system in place.

This is outright fraud. These senators have repeatedly lied to the American people about where they stood on one of the signature issues facing the nation.

Obamacare has failed. Premiums are higher than ever and the options on insurance marketplaces are dwindling. In the meantime, the employer mandates still create a disincentive against hiring full-time employees and Medicaid expansion is bankrupting state budgets.

Manning concluded, “The American people have become all too accustomed to politicians who say one thing and do another. The Senate Six have proven that the public’s cynicism about politicians is well-placed, for if they had just kept word, Obamacare would be history. The days ahead will prove whether the GOP majority in the Senate is able to keep their election promises. If they fail, fantasies of a 60-vote Republican Senate will be replaced by fears of a Democrat majority.”

GOP Sen Murkowski: ‘We Should Not Repeal Without a Replacement,’ Becomes Third GOP Vote Against Repeal Then Replace

While speaking to reporters on Tuesday, Senator Lisa Murkowski (R-AK) came out against the plan to repeal Obamacare and replace it later, making her the third GOP vote against the plan and putting it below the number of votes it needs to pass.

Murkowski said of the motion to proceed on the repeal now and replace later plan, “I’m not there.”

When asked if she would vote against the motion to proceed, Murkowski responded, “I said in January, we should not repeal without a replacement, and just an indefinite hold on this just creates more chaos and confusion.”

Murkowski joins Republican Senators Susan Collins of Maine and of Shelley Moore Capito West Virginia in opposing the plan to repeal now and replace later. The three Republican no votes mean that without Democratic support, the repeal now and replace later plan does not have the votes to pass.

PHOENIX (AP) — Sen. John McCain’s absence from the Senate as he recovers from surgery for a blood clot has led the GOP leadership to postpone consideration of health care legislation already on the brink.

Senate Majority Leader Mitch McConnell said Saturday night he was deferring action on the measure as McCain recovers at his home in Arizona. Surgeons in Phoenix removed a blood clot from above McCain’s left eye on Friday. The 80-year-old Senate veteran was advised by doctors to remain in Arizona next week, his office said.

“While John is recovering, the Senate will continue our work on legislative items and nominations, and will defer consideration of the Better Care Act,” McConnell said in a statement.

A close vote had already been predicted for the GOP health care bill, with all Democrats and independents coming out against it and some Republicans opposed or undecided. With the GOP holding a 52-48 majority, they can afford to lose only two Republicans. Vice President Mike Pence would break a tie for final passage.

Two Republicans, Rand Paul of Kentucky and Susan Collins of Maine, have already said they’ll vote against the measure.

A procedural vote expected in the coming days had been cast as a showdown over the measure designed to replace President Barack Obama’s health care law, commonly called Obamacare.

McConnell and other GOP leaders have been urging senators to at least vote in favor of opening debate, which would allow senators to offer amendments. In recent days GOP leaders have expressed optimism that they were getting closer to a version that could pass the Senate.

In Phoenix, Mayo Clinic Hospital doctors said McCain underwent a “minimally invasive” procedure to remove the nearly 2-inch (5-centimeter) clot and that the surgery went “very well,” a hospital statement said. McCain was reported to be resting comfortably at his home in Arizona.

Pathology reports on the clot were expected in the next several days.

McCain is a three-time survivor of melanoma. Records of his medical exams released in 2008 when he was the GOP candidate for president showed that he has had precancerous skin lesions removed and had an early stage squamous cell carcinoma, an easily cured skin cancer, removed.

Rep. Maxine Waters (D-CA), a leader of the “resistance,” hasn’t been doing too well lately. She told MSNBC’s Chris Hayes that, if the Republican healthcare bill is passed, “700 billion” people will lose health access. Keep in mind that our planet has about 7.3 billion people living on it. We knew the GOP proposal was ambitious, but not quite that ambitious! Maybe there should be an ongoing senility test for congresspeople?

GOP Rep Gohmert to Trump: Work with Freedom Caucus, We Stood By When Priebus, Ryan ‘Abandoned’ You

On Fox News Channel’s “Sunday Morning Futures,” House Freedom Caucus Member Sen. Louie Gohmert (R-TX) urged President Donald Trump to work with the freedom caucus instead of establishment Republican leaders like House Speaker Paul Ryan and White House chief of staff Reince Priebus.

Gohmert explained how Trump and the Freedom Caucus came to agreement on two separate occasions during the Obamacare replacement negotiations, but establishment Republicans rejected them.

“The president’s administration will either succeed or fail over the next 30 days,” Gohmert stated. “He can work with people that got him there that defended him when others like Ryan and the establishment were running scared, or he can work with us to help him fulfill his promises.”